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"I'd rather have a nurse from the hospital any day, one who's looking for a career change, rather than a burned-out home health nurse." I stared at Joan, an RN who was director of skilled care for an agency, and said, "Excuse me, could you say that again?" As a nurse journalist, I listen to nurses' stories. This was a story I hadn't heard before.


Joan was my second interview that day after Ramona, an RN clinical manager at another agency. Both graciously shared their stories and talked openly about trends and challenges in recruitment and orientation. Both described the scenario of RNs moving from acute care to home care, women primarily in their 40s seeking something else.


For Ramona, orienting this staff presents challenges. "[You] can teach, review, retrain the skills part in 2 weeks and check off competencies but the type of critical thinking necessary for success takes much longer. While you can go over the paperwork burden, these new nurses can't really appreciate what that means. They have a hard time grasping the primary nursing concept of home care." At first, new clinicians were assigned to preceptors and experienced home care clinicians working part time. This wasn't ideal. "New nurses need a true preceptor, someone who is more accessible."


Joan loves to hear, "I've been a nurse for 15 years." For her these midlife seekers are refreshing professionals who are eager to learn, willing to adapt to the way the agency does business. "They go the extra mile for a chance to leave the world of 12-hour shifts, where the patient they care for today is often not there the next day. It's great, they're constantly asking questions." She feels these clinicians don't present a challenge, they are looking for challenges. They love the chance to give full attention to one patient and family at a time, even if it comes with mileage and paperwork.


What can we make of these stories? Experienced clinicians making a midlife career change from acute care to home care will continue.


* A national home care agency survey in 2000 reported a 21% turnover rate for RNs (Hospital & Healthcare Compensation Service, 2000).


* The number of nurses in their 40s to 50s increased from 20% of the nursing workforce in 1980 to 35% in 2000 (Buerhaus et al., 2000a).


* By 2010, approximately 40% of the nursing workforce will likely be older than 50 years (Buerhaus et al., 2000b).



Listening to Joan and Ramona, I came away wondering if we're missing something. What are we doing to meet these clinicians' unique needs? Do orientation models maximize the freshness and excitement that these nurses can bring? Do they meet the needs of adult learners, especially those with strong clinical skills?


Agencies continue to have a need for experienced clinicians. How do we honor their knowledge, even if some are burned out? What about new graduates? What if clinical managers embraced a revitalized orientation approach blending the best qualities of these professionals?


Picture these clinicians sharing stories, a powerful way to exchange knowledge. Each contributing best practice experience: new graduates and acute care nurses from a medical model and experienced home care clinicians from a functional health model. What better combination for a strong and viable home care workforce!!




Buerhaus, P., Staiger D., & Auerbach D. (2000a). Nursing: Transforming care at the bedside. Nursing Economics, 18 (6), 278-303. [Context Link]


Buerhaus, P., Staiger D., & Auerbach D. (2000b). Implications of an aging registered nurse workforce. JAMA, 283 (22), 2948-2954. [Context Link]


Hospital & Healthcare Compensation Service. (2000). Homecare salary and benefits report. Oakland, NJ: Hospital & Healthcare Compensation Service. [Context Link]